Craniofacial implants in a failed autologous reconstruction of microtia: a case report

Plastic surgical reconstruction is considered to be the gold standard for the repair of microtia as the results are permanent and constructed from the patient’s own tissue; however, the multiple surgeries required and the difficulty in attaining adequate cosmetic results often result in patients choosing a prosthesis as a long-term rehabilitation. Advances in osseointegration in the craniofacial region have improved the outcomes with auricular prosthetics by providing a reliable method of attachment of the prosthesis and increasing patient acceptance. A case presentation illustrates the results of both treatment modalities and examines the outcomes on the same patient.

Systematic Review of Clinical Applications of CAD/CAM Technology for Craniofacial Implants Placement and Manufacturing of Nasal Prostheses

The aim of this systematic review was to gather the clinical and laboratory applications of CAD/CAM technology for preoperative planning, designing of an attachment system, and manufacturing of nasal prostheses. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, an electronic search was carried out. Only human clinical studies involving digital planning for the rehabilitation of facial defects were included. A total of 21 studies were included with 23 patients, which were virtually planned through different planning software. The most common preoperative data for digital planning were CT scans in nine cases, CBCT in six cases, and laser scans in six cases. The reported planning softwares were Mimics in six cases, Geomagic Studio software in six cases, ZBrush in four cases, and Freeform plus software in four cases. Ten surgical templates were designed and printed to place 36 implants after digital planning, while post-operative assessment was done in two cases to check the accuracy of planned implants. Digital 3D planning software was reported for presurgical planning and craniofacial implants placement, fabrication of molds, designing of implants, designing of retentive attachments, and printing of silicone prostheses. Digital technology has been claimed to reduce the clinical and laboratory time; however, the equipment cost is still one of the limitations.

Synthetic skull bone defects for automatic patient-specific craniofacial implant design

Patient-specific craniofacial implants are used to repair skull bone defects after trauma or surgery. Currently, cranial implants are designed and produced by third-party suppliers, which is usually time-consuming and expensive. Recent advances in additive manufacturing made the in-hospital or in-operation-room fabrication of personalized implants feasible. However, the implants are still manufactured by external companies. To facilitate an optimized workflow, fast and automatic implant manufacturing is highly desirable. Data-driven approaches, such as deep learning, show currently great potential towards automatic implant design. However, a considerable amount of data is needed to train such algorithms, which is, especially in the medical domain, often a bottleneck. Therefore, we present CT-imaging data of the craniofacial complex from 24 patients, in which we injected various artificial cranial defects, resulting in 240 data pairs and 240 corresponding implants. Based on this work, automatic implant design and manufacturing processes can be trained. Additionally, the data of this work build a solid base for researchers to work on automatic cranial implant designs.

Craniofacial implants: what maxillofacial surgeon needs to understand

Since discovery of the osseointegration of titanium in the 1950s, dental implants have been made of titanium the 1960s. In 1977, the first extraoral titanium implant was inserted for craniofacial rehabilitation aims. Craniofacial implants start to be popular for craniofacial reconstruction and rehabilitation. Craniofacial implants become as revaluation in rehabilitation fields, to day even large facial defect can be reconstructed via this surgical –prosthetic technique. The aim of this review is to explain and clarify the indications and techniques for such procedure.

3D printed composite materials for craniofacial implants: current concepts, challenges and future directions

Millions of craniofacial surgeries are performed annually worldwide for craniofacial bones’ replacement and augmentation. This represents a significant economic burden as well as aesthetic expectations. Autografts and allografts are the first choice for treatment of craniofacial defects; however, their limited availability and difficulty to shape have led to investigation for alternative strategies. Biomaterial-based approaches have been used for implantation as they have ample supply but their processing through conventional technologies present several drawbacks; the major one relates to the poor versatility towards the production of patient-specific implants. Additive manufacturing has gained considerable attention during the last decade, as it allows the manufacturing of implants according to patient need. Biomaterial implants can be additively manufactured but have one or more limitations of stress shielding, radiopacity, high strength to weight ratio and limited bone integration. Over the last few decades, composites are investigated to surmount the limitations with traditional implants and also improve their bone integration. This review provides an overview of the most recent polymeric composite-based biomaterials that have been used in combination with 3D printing technology for the development of patient-specific craniofacial implants. Starting with the conventional treatments, biomaterials available for the craniofacial implants, the additive manufacturing rationale are discussed. Also, the main challenges still associated with 3D printing of polymer-based composites are critically reviewed and the future perspective presented.

Accuracy Assessment of Molded, Patient-Specific Polymethylmethacrylate Craniofacial Implants Compared to Their 3D Printed Originals

The use of patient-specific implants (PSIs) in craniofacial surgery is often limited due to a lack of expertise and/or production costs. Therefore, a simple and cost-efficient template-based fabrication workflow has been developed to overcome these disadvantages. The aim of this study is to assess the accuracy of PSIs made from their original templates. For a representative cranial defect (CRD) and a temporo-orbital defect (TOD), ten PSIs were made from polymethylmethacrylate (PMMA) using computer-aided design (CAD) and three-dimensional (3D) printing technology. These customized implants were measured and compared with their original 3D printed templates. The implants for the CRD revealed a root mean square (RMS) value ranging from 1.128 to 0.469 mm with a median RMS (Q1 to Q3) of 0.574 (0.528 to 0.701) mm. Those for the TOD revealed an RMS value ranging from 1.079 to 0.630 mm with a median RMS (Q1 to Q3) of 0.843 (0.635 to 0.943) mm. This study demonstrates that a highly precise duplication of PSIs can be achieved using this template-molding workflow. Thus, virtually planned implants can be accurately transferred into haptic PSIs. This workflow appears to offer a sophisticated solution for craniofacial reconstruction and continues to prove itself in daily clinical practice.